Table 1.

Summary Characteristics of Studies Represented in the Proposed Conceptual Framework

Author	Purpose	Study Design	Sample	Depression-related Measures	Results
Beck, C.T., Froman, Robin D., & Bernal, H. (2005)	To explore associations between acculturation levels and postpartum depressive symptomatology and PPD in Hispanic subgroups.	Secondary data analysis	Two Hispanic women samples were analyzed in two phases: First phase 1 included 377 women who were on average 10 weeks postpartum and the second phase sample consisted of 150 who were one month postpartum	PDSS-Spanish Version; Short Acculturation Scale	Acculturation was not significantly associated with postpartum depression.
Bloch, M., Rubinow, D. R., Schmidt, P. J., Lotsikas, A., Chrousos, G. P., & Cizza, G. (2005)	Examine the effects of high concentration gonadal steroids on stress response in women with and without a history of postpartum depression.	Experimental	Twelve women with a history of postpartum depression (n = 5) and seven matched control without (n = 7) a past postpartum depression. Women were between 22–45 years old.	Edinburgh Postnatal Depression Scale (EPDS) and the Structured Clinical Interview for DSM-IV (SCID)	Women with a history of postpartum depression exhibited higher HPA axis reactivity to the high levels of gonadal steroids.
Cox, E. Q., Stuebe, A., Pearson, B., Grewen, K., Rubinow, D., & Meltzer-Brody, S. (2015)	Determine if there is an association between dysregulated oxytocin levels and HPA reactivity in women with postpartum depression in during breastfeeding and stress testing.	Experimental	Prospective cohort of 47 women whom were assessed at 8 weeks postpartum.	Edinburgh Postnatal Depression Scale (EPDS)	Women with postpartum depression had lower oxytocin concentration levels and higher HPA axis reactivity during breastfeeding and stress testing compared to women without depression.
Davila, M., McFall, S. L., & Cheng, D. (2009)	Determine prevalence of postpartum depression and its association with acculturation among U.S.-and Mexico-born Latinas.	Cross-sectional	439 prenatal and postpartum women	Center for Epidemiologic Studies Depression (CES-D) Scale	More than a third reported depression symptoms (21% moderate and 15% high). Results showed a positive association between acculturation and depressive symptoms. Also, single and pregnant women reported more depressive symptoms.
D'Anna-Hernandez, K. L., Aleman, B., & Flores, A. M. (2015)	Determine the unique contributions acculturation, acculturative stress and perceived discrimination have on prenatal Mexican-American mothers’ mental health while controlling for general and perceived stress.	Cross-sectional	98 prenatal Mexican and Mexican-American women between 18 and 45 years of age	Center for Epidemiologic Studies Depression (CES-D) Scale	An estimated 40% reported depressive symptoms. Results showed that acculturative stress and perceived stress predicted increased depressive symptoms. Women who experienced more acculturative stress identified with a blend of Mexican and American cultural values. Also, the Mexican cultural value of respect was found to be protective.
Garabedian, M.J., Lain, K.Y., Hansen, W.F., Garcia, L.S., Williams, C.M., & Crofford, L.J. (2011)	Explore the relationship between childhood and adult violent victimization and a history of postpartum depression.	Secondary data analysis	5380 women from the Kentucky Women's Health Registry, 18 years and older	Yes/No to question regarding history of postpartum depression	A history of violent victimization was associated with reporting a postpartum depression. A higher number of violent traumas had a stronger association with a reported history of postpartum depression.
Heim, C., Newport, D. J., Heit, S., Graham, Y. P., Wilcox, M., Bonsall, R., . . . Nemeroff, C. B. (2000)	Determine whether early life abuse is associated with stress reactivity to a laboratory stressor in women with or without depression.	Experimental	49 women between the 18 and 45 years of age.	Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)	Women with a history of childhood abuse exhibited increased HPA axis response to a laboratory stress, particularly among women with depression.
Jackson, C. L., Ciciolla, L., Crnic, K. A., Luecken, L. J., Gonzales, N. A., & Coonrod, D. V. (2015)	Establish the prevalence of victims of intimate partner violence (IPV), investigate the relationship between IPV, demographic characteristics, sociocultural factors (e.g., acculturation) and postpartum depression.	Cross-sectional	320 perinatal low-income U.S. - and foreign-born Mexican and Mexican-American women	Edinburgh Postnatal Depression Scale (EPDS)	Women with a history of IPV reported elevated levels of depressive symptoms. After controlling for key demographic characteristics, increased number of violent traumatic events increased likelihood of reporting a history of postpartum depression.
Jolley, S. N., Elmore, S., Barnard, K. E., & Carr, D. B. (2007)	Determine if women with postpartum depression demonstrated dysregulated HPA axis response to a physiological stressor (treadmill exercise) compared to nondepressed postpartum women.	Prospective, Experimental	22 prenatal women followed prospectively for approximately 16 weeks	Postpartum Depression Screening Scale (PDSS)	At six and 12 weeks postpartum, women with depression had higher adrenocorticotropic hormone (ACTH) and lower cortisol response to the physiological stressor compared to nondepressed mothers.
Magiakou, M. A., Mastorakos, G., Rabin, D., Dubbert, B., Gold, P. W., & Chrousos, G. P. (1996)	Evaluate HPA axis function (i.e., ACTH concentration levels) and psychological well-being in late pregnancy through the 20 weeks postpartum in a sample of health pregnant women.	Prospective, Experimental	Prospective sample of 17 nondepressed pregnant women.	Hamilton Rating Scale for Depression (HRS-D)	Women who developed mild depressive symptoms (i.e., baby blues) or major depression during the postpartum period had suppressed ACTH response to exogenous administration of corticotropic-releasing hormone (CRH).
Rodriguez, M. A., Heilemann, M. V., Fielder, E., Ang, A., Nevarez, F., & Mangione, C. M. (2008).	Examine intimate partner violence, strength factors, and adverse social behavioral circumstances in relation to the incidence of depression or PTSD among pregnant Latinas.	Cross-sectional	210 prenatal Latina women in the second and third trimester between the ages of 18 and 42 years old with and without histories of intimate partner violence	Beck Depression Inventory Fast Screen (BDI-FS)	Approximately 44% of participants had histories of intimate partner violence. Results showed that pregnant Latinas who had experienced intimate partner violence had more than twice the odds of reporting elevated levels of depressive or PTSD symptoms. However, intimate partner violence was only significantly associated with depression after controlling for covariates.
Segre, L. S., O'Hara, M. W., Arndt, S., & Stuart, S. (2007)	Examine the relationship between income, education and occupational prestige and the prevalence of postpartum depression in a heterogeneous sample of postpartum women.	Cross-sectional	4,332 postpartum women (M = 4.6 months), 18 years of age and older	Inventory to Diagnose Depression (IDD)	Income was the most significant predictor of postpartum depression. Low-income women were overrepresented among those with depression.
Stuebe, A. M., Grewen, K., & Meltzer-Brody, S. (2013)	Assess neuroendocrine function among lactating postpartum women with and without depression or anxiety.	Prospective, Experimental	47 prenatal women followed for approximately 12 weeks	Edinburgh Postnatal Depression Scale (EPDS)	Depression and anxiety were negatively correlated with oxytocin levels. At 8 weeks postpartum, breastfeeding women with higher depressive and anxious symptoms had lower levels of oxytocin.
Surkan, P. J., Peterson, K. E., Hughes, M. D., & Gottlieb, B. R. (2006)	Explore the relationship between social support and social networks in a racially/ethnically diverse sample of postpartum women.		415 postpartum women (White, African American, and Latina), mean age = 29.0 (SD = ±6.2)	Center for Epidemiologic Studies Depression (CES-D) Scale	A history of discrimination was associated with depression. Less acculturated women reported elevated depressive symptoms. Higher social support was associated with fewer depressive symptoms.
Valentine, J. M., Rodriguez, M. A., Lapeyrouse, L. M., & Zhang, M. (2011)	Evaluate recent intimate partner violence as a potential prenatal risk factor for postpartum depression among pregnant Latina women.	Prospective, Observational	210 prenatal Latina women between 18 and 42 years of age who were and were not exposed to intimate partner violence	Beck Depression Inventory Fast Screen (BDI-FS)	In the postpartum period, almost 44% of women experienced elevated depressive symptoms, compared to 33% in the prenatal period. Prenatally, nearly 44% experienced recent or remote intimate partner violence (IPV). Results indicated prenatal depression, recent IPV, low social support, and non-IPV trauma as predictors of postpartum depression. However, only recent IPV and prenatal depression showed highly significant associations in multivariate analyses.
Zeiders, K. H., Umaña-Taylor, A. J., Updegraff, K.A., & Jahromi, L. B. (2015)	Examine changes in Mexican adolescent mothers’ depressive symptoms and evaluate potential contributing and protective factors.	Longitudinal	204 unmarried adolescent mothers of Mexican descent between the ages of 15 and 18 from the third trimester to3 years postpartum	Center for Epidemiologic Studies Depression (CES-D) Scale	Results indicated that depressive symptoms declined in adolescents mothers of Mexican origin after they transitioned into motherhood. Both higher acculturative and enculturative stress were associated with elevated depressive symptoms. However, the association between depressive mod and acculturative stress only held for U.S.-born mothers.